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Study: “Worrisome” Changes in Cardiovascular Function Immediately after Vaping, Smoking Traditional Cigarettes

Vaping device and cigarettes in the man's hand, concept of choosing the type of cigarette

©Balint Radu/AdobeStock

Chronic users of either e-cigarettes or traditional, combustible cigarettes experienced acute changes in cardiovascular function compared to individuals who did not use nicotine, according to new data presented at the American Heart Association (AHA) Scientific Sessions 2022, held in Chicago and virtually, November 5-7, 2022.

Persons who regularly used electronic nicotine delivery devices (ENDS) showed acute increases in blood pressure (BP), heart rate (HR), vasoconstriction, and reductions in time domain HR variability and treadmill performance after using ENDS, effects similar to those seen in users of combustible cigarettes.

Findings come from 2 abstracts presented by researchers from the Cardiac and LUng E-cig Smoking (CLUES) cross-sectional study, conducted between March 2019 and March 2022.

“Immediately after vaping or smoking, there were worrisome changes in blood pressure, heart rate, heart rate variability and blood vessel tone (constriction),” said lead author of the first CLUES analysis Matthew C. Tattersall, DO, MS, assistant professor of medicine, University of Wisconsin School of Medicine and Public Health, associate director of preventive cardiology, UW Health, Madison, in an AHA press release.

The 395 participants in the CLUES study included:

  • 164 (mean age, 27.4 years; 39% women; 86% White) adults who reported exclusively using ENDS for an average of 4.1 years.
  • 117 (mean age, 42.8 years; 44% women; 56% White) persons who solely smoked traditional, combustible cigarettes for an average of 23 years.
  • 114 (mean age, 30.8 years; 50% women; 69% White) adults who reported never smoking or vaping and who currently had negative urine tests for nicotine use.

In the first analysis1, researchers measured systolic and diastolic BP, HR, brachial artery diameter, and time domain HR variability (root mean square differences in successive normal intervals [RMSSD]; % adjacent normal intervals >50 ms [PNN50]) before and up to 15 minutes after participants vaped or smoked. Investigators then compared the before-and-after measures to measurements taken 10-15 minutes apart in the control group of never users.

Results showed that, compared to adults in the control arm, vapers had greater increases in systolic BP, diastolic BP, and HR (all p<.002) and greater reductions in brachial artery diameter, RMSSD, and PNN50 (all p<0.003), with values similar to chronic smokers.

The second analysis2 assessed participants’ performance on exercise stress testing and showed that adults who vaped consistently performed worse than never users on the following 4 treadmill exercise parameters that predict adverse cardiovascular disease outcomes: peak METs (p<.001), peak rate-pressure product (p=.020), HR reserve (p<.001), and 60-second HR recovery (p=.025), with intermediate values compared to smokers.

“Our findings from the CLUES study raise concerns about the potential harms of chronic use of electronic nicotine delivery systems, particularly for cardiovascular disease,” said CLUES principal investigator James H. Stein, MD, director of preventive cardiology, UW Health, in the release. “We did not study the long-term effects of vaping, use of vaping as a smoking cessation aid or the effectiveness or safety of vaping in that context. However, these findings are concerning because they indicate vaping may increase cardiovascular risk.

“The message for people who smoke combustible cigarettes is the same as always – try to quit using tobacco and nicotine products and seek support from your physician and community to increase your chances of success,” concluded Stein.


  1. Tattersall MC, Hughey CM, Stein JH, et al. Acute effects of nicotine-containing product challenges on cardiovascular and autonomic function among electronic cigarette vapers, combustible cigarette smokers, and controls: The CLUES study. Abstract presented at the American Heart Association Scientific Sessions 2022; November 1-4, 2022; Chicago, IL.
  2. Tattersall MC, Hughey CM, Stein JH, et al. Differences in treadmill exercise stress testing parameters among electronic cigarette vapers, combustible cigarette smokers, and controls: The CLUES study. Abstract presented at the American Heart Association Scientific Sessions 2022; November 1-4, 2022; Chicago, IL.

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